Healthcare Provider Details

I. General information

NPI: 1629106950
Provider Name (Legal Business Name): ROY E SCUDAMORE CERT. PROSTHETIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S DIVISION AVE
ORLANDO FL
32805-4715
US

IV. Provider business mailing address

4702 NW 80TH COURT
OCALA FL
34482
US

V. Phone/Fax

Practice location:
  • Phone: 407-843-8040
  • Fax:
Mailing address:
  • Phone: 352-840-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberPRO88
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: